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HEALTH HISTORY
Patients Name Date of BirthDateAnswer all questions by circling Yes (Y) or No (N)
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5.6.
7.8. Are you in good health? ................................................. Y
Has
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What is ask me 3 good?
Ask me 3 good is a program designed to encourage thoughtful questions and conversation.
Who is required to file ask me 3 good?
Anyone interested in sparking meaningful dialogue can participate in ask me 3 good.
How to fill out ask me 3 good?
To participate in ask me 3 good, simply ask three good questions and engage in thoughtful conversation.
What is the purpose of ask me 3 good?
The purpose of ask me 3 good is to promote critical thinking and deeper discussions among participants.
What information must be reported on ask me 3 good?
Participants are expected to report the three questions they ask as part of the program.
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